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肾盂输尿管梗阻与肾结石:病因及治疗

Ureteropelvic obstruction and renal stones: etiology and treatment.

作者信息

Skolarikos Andreas, Dellis Andreas, Knoll Thomas

机构信息

2nd Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece.

出版信息

Urolithiasis. 2015 Feb;43(1):5-12. doi: 10.1007/s00240-014-0736-2. Epub 2014 Nov 2.

Abstract

The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were "ureteropelvic junction obstruction," "renal calculi" and "renal stones." Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction.

摘要

在过去20年中,输尿管肾盂连接部梗阻(UPJO)合并肾结石的同期手术治疗不断发展;因此,理想的微创技术仍存在争议。腹腔镜手术和机器人辅助腹腔镜手术能够实现精确的手术操作,并且被认为可以简化手术的重建步骤,尤其是在治疗伴有大结石的复杂病例时。本研究的目的是总结现有的微创技术的围手术期和功能结局。使用MEDLINE数据库中的自由文本协议对文献进行了非系统综述。使用的检索词为“输尿管肾盂连接部梗阻”、“肾结石”和“肾石症”。此外,在本综述的结构中,还对所选论文参考文献列表中引用的其他重要相关研究进行了评估。目前,现有证据表明,腹腔镜技术和机器人辅助技术在UPJO重建和肾结石清除领域均提供了出色的手术解决方案。在经验丰富的外科医生手中,腹腔镜和机器人肾盂成形术联合结石清除术是一种安全的手术,结石清除率高且UPJ通畅。微创肾盂成形术应成为合并肾结石和输尿管肾盂连接部梗阻的首选治疗方法。

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